Thrombin is a serine protease present in blood plasma in the form of a precursor, prothrombin. Thrombin plays a central role in the mechanism of blood coagulation by converting the solution plasma protein, fibrinogen, into insoluble fibrin.
Edwards et al., J. Amer. Chem. Soc., (1992) vol. 114, pp. 1854-63, describes peptidyl a-ketobenzoxazoles which are reversible inhibitors of the serine proteases human leukocyte elastase and porcine pancreatic elastase.
European Publication 363 284 describes analogs of peptidase substrates in which the nitrogen atom of the scissile amide group of the substrate peptide has been replaced by hydrogen or a substituted carbonyl moiety.
Australian Publication 86245677 also describes peptidase inhibitors having an activated electrophilic ketone moiety such as fluoromethylene ketone or a-keto carboxyl derivatives.
R. J. Brown et al., J. Med. Chem., Vol. 37, pages 1259-1261 (1994) describes orally active, non-peptidic inhibitors of human leukocyte elastase which contain trifluoromethylketone and pyridinone moieties.
H. Mack et al., J. Enzyme Inhibition, Vol. 9, pages 73-86 (1995) describes rigid amidino-phenylalanine thrombin inhibitors which contain a pyridinone moiety as a central core structure.
The invention includes compounds for inhibiting loss of blood platelets, inhibiting formation of blood platelet aggregates, inhibiting formation of fibrin, inhibiting thrombus formation, and inhibiting embolus formation in a mammal, comprising a compound of the invention in a pharmaceutically acceptable carrier. These compounds may optionally include anticoagulants, antiplatelet agents, and thrombolytic agents. The compounds can be added to blood, blood products, or mammalian organs in order to effect the desired inhibitions.
The invention also includes a compound for preventing or treating unstable angina, refractory angina, myocardial infarction, transient ischemic attacks, atrial fibrillation, thrombotic stroke, embolic stroke, deep vein thrombosis, disseminated intravascular coagulation, ocular build up of fibrin, and reocclusion or restenosis of recanalized vessels, in a mammal, comprising a compound of the invention in a pharmaceutically acceptable carrier. These compounds may optionally include anticoagulants, antiplatelet agents, and thrombolytic agents.
The invention also includes a method for reducing the thrombogenicity of a surface in a mammal by attaching to the surface, either covalently or noncovalently, a compound of the invention.
Compounds of the invention, useful as thrombin inhibitors and having therapeutic value in for example, preventing coronary artery disease, have the following structure: 
or a pharmaceutically acceptable salt thereof, wherein b is NY1 or O; c is CY2 or N;
d is CY3 or N; e is CY4 or N; f is CY5 or N; g is CY6 or N; Y4, Y5, and Y6 are independently hydrogen, C1-4 alkyl, or halogen; Y1 and Y2 are independently hydrogen, C1-4 alkyl, C3-7 alcycloalkyl, halogen, NH2, OH or C1-4 alkoxy, and Y3 is hydrogen, C1-4 alkyl, C3-7 alcycloalkyl, halogen, xe2x80x94CN, NH2, OH or C1-4 alkoxy;
A is 
W is
hydrogen,
R1,
R1OCO,
R1CO,
R1SO2,
R1CH2)nNHCO, or
(R1)2CH(CH2)nNHCO,
wherein n is 0-4;
W1 is
hydrogen, OH, CH3CO, or R2CH2SO2CH2;
R1 is
R2,
R2(CH2)mC(R8)2, where m is 0-3, and each R8 can be the same or different,
(R2)(OR2)CH(CH2)p, where p is 1-4, 
xe2x80x83where m is 0-3;
R2C(R8)2(CH2)m, wherein m is 0-3, and each R8 can be the same or different, wherein (R8)2 can also form a ring with C represented by C3-7 alcycloalkyl,
R2CH2C(R8)2(CH2)q, wherein q is 0-2, and each R8 can be the same or different, wherein (R8)2 can also form a ring with C represented by C3-7 alcycloalkyl,
(R2)2CH(CH2)r, where r is 0-4 and each R2 can be the same or different, and wherein (R2)2 can also form a ring with CH represented by C3-7 cycloalkyl, C7-12 bicylic alkyl, C10-16 tricylic alkyl, or a 5- to 7-membered mono- or bicyclic heterocyclic ring which can be saturated or unsaturated, and which contains from one to three heteroatoms selected from the group consisting of N, O and S,
R2O(CH2)p, wherein p is 1-4,
R2CF2C(R8)2,
(R2CH2)2CH, where R2 can be the same or different,
R2SO2,
R2CH2SO2,
R2CH2O(CH2)p, wherein p is 1-4,
(R2(CH2)q)2N(CH2)p, wherein q is 1 or 2 and p is 1-4,
R2(COOR6)(R8)C(CH2)r, wherein ris 1-4
R2NR11(CH2)p, where R11 is hydrogen or CH3 and p is 0, 1 or 2, 
xe2x80x83wherein r is 1-4,
R2(COOR6)(CH2)r, where r is 1-4;
R2 and R5 are independently
hydrogen,
phenyl, unsubstituted or substituted with one or more of C1-4 alkyl, C1-4 alkoxy, halogen, hydroxy, COOH, CONH2, CH2OH, CO2R7, where R7 is C1-4 alkyl, or SO2NH2,
naphthyl,
biphenyl,
a 5- to 7- membered heterocyclic saturated or unsaturated ring, or a 9- to 10-membered bicyclic fused ring system, wherein the rings are independently heterocyclic or non-heterocyclic and saturated or unsaturated, wherein the heterocyclic ring contains from one to four heteroatoms selected from the group consisting of N, O and S, and wherein the heterocyclic or non-heterocyclic ring is unsubstituted or substituted with
halogen,
hydroxy,
C1-4 alkyl,
C3-7 alcycloalkyl,
xe2x80x94CN,
xe2x80x94CON(R7)2, wherein R7, same or different, is hydrogen, unsubstituted C1-4 alkyl, or C1-4kyl substituted with xe2x80x94OH,
xe2x80x94OCH2R7, wherein R7 is C3-7 cycloalkyl or COOH,
xe2x80x94SCH3,
xe2x80x94COR7, wherein R7 is C1-4 alkyl or amino,
phenyl, unsubstituted or substituted with halogen,
xe2x80x94SO2CH3,
xe2x80x94OCH2CONR7, wherein R7 is C3-7 cycloalkyl,
xe2x80x94CH2R7, wherein R7 is C3-7 cycloalkyl or phenyl,
C1-7 alkyl, unsubstituted or substituted with one or more of
hydroxy,
COOH,
amino,
aryl,
C3-7 alcycloalkyl,
CF3,
N(CH3)2,
xe2x80x94C1-3alkylaryl,
heteroaryl, or
heterocycloalkyl,
CF3,
C3-7 alcycloalkyl, unsubstituted or substituted with aryl or xe2x80x94OCH2R7 wherein R7 is C3-7 cycloalkyl
C7-12 bicyclic alkyl, or
C10-16 tricyclic alkyl;
R3, R4 and R6 are independently selected from the group consisting of
hydrogen,
C1-4 alkyl,
C3-7 cycloalkyl,
halogen,
phenyl, unsubstituted or substituted with halogen, CF3 or C1-5 alkyl,
R12CO, where R12 is
hydrogen,
C1-5 alkyl,
pyrrolidine unsubstituted, monosubstituted or independently disubstituted with C1-4 alkyl,
piperidine unsubstituted, monosubstituted or independently disubstituted with C1-4 alkyl, or
azepine unsubstituted, monosubstituted or independently disubstituted with C1-4 alkyl;
a 5-7 membered heterocyclic saturated or unsaturated ring wherein the ring contains one to four heteroatoms selected from the group consisting of N, O and S, and wherein the ring is unsubstituted or substituted with phenyl, COCH3, unsubstituted C1-4 alkyl, or C1-4 alkyl substituted with xe2x80x94OH or phenyl,
xe2x80x94CN,
xe2x80x94SCH3,
xe2x80x94SOCH3,
xe2x80x94SO2CH2, R10 where R10 is hydrogen or C3-7 alcycloalkyl, or trifluoromethyl;
X is
hydrogen, or
halogen;
Z is CH2, S, or SO2;
R8 is
hydrogen,
phenyl, unsubstituted or substituted with one or more of C1-4 alkyl, C1-4 alkoxy, halogen, hydroxy, COOH, CONH2,
halogen,
naphthyl,
biphenyl,
a 5- to 7- membered mono- or a 9- to 10-membered bicyclic heterocyclic ring which can be saturated or unsaturated, and which contains from one to four heteroatoms selected from the group consisting of N, O and S,
C1-4 alkyl, unsubstituted or substituted with one or more of
hydroxy,
COOH,
NHCH3,
amino,
aryl,
heteroaryl, or
heterocycloalkyl,
CF3,
C3-7 alcycloalkyl,
C7-12 bicyclic alkyl, or
C10-16 tricyclic alkyl.
A class of compounds of the invention, or a pharmaceutically acceptable salt thereof, includes those wherein A is 
A subclass of compounds of this class, or a pharmaceutically able salt thereof, includes those wherein
Y1, Y2, Y3, Y4, Y5, and Y6 are independently hydrogen, C1-4 alkyl, N2 or Cl; W is hydrogen or R1;
R1 is R2,
R2SO2,
R2CH2SO2, or 
xe2x80x83where m is 0-3;
R2 and R5 are independently selected from the group consisting of hydrogen, C1-7 alkyl unsubstituted or substituted with aryl, C3-7 cycloalkyl, or heteroaryl; and R3 and R4 are independently selected from the group consisting of hydrogen and C1-4 alkyl;
and Z is SO2.
In a group of compounds of this subclass, or a pharmaceutically acceptable salt thereof, Y1, Y2, Y3, Y4, Y5, and Y6 are independently hydrogen, methyl, NH2 or Cl; W is hydrogen or 
R5 is 
R3 and R4 are independently selected from the group consisting of hydrogen and methyl.
In a subgroup of this group of compounds, b is NH, N(CH3) or O, c is CH, C(CH3) or N, d is CH, N, C(NH2), C(Cl), or C(CH3), e is CH, N or C(CH3), f is CH, C(CH3), or N, and g is CH or N.
Examples of this group are listed below in Table 1. Inhibitory activity of compounds of the invention is represented by xe2x80x9c**xe2x80x9d, indicating Ki greater than or equal to 20 nM, or xe2x80x9c*xe2x80x9d, indicating Ki less than 20 nM. Values are as determined according to the in vitro assay described later in the specification.

One family of compounds of the invention, and pharmaceutically acceptable salts thereof, includes 
A subfamily of this family of compounds of the invention, and pharmaceutically acceptable salts thereof, includes 
The compounds of the present invention, may have chiral centers and occur as racemates, racemic mixtures and as individual diastereomers, or enantiomers with all isomeric forms being included in the present invention. The compounds of the present invention may also have polymorphic crystalline forms, with all polymorphic crystalline forms being included in the present invention. Also included within the invention are tautomers of compounds of the invention, e.g. where b is NH and d is N.
When any variable occurs more than one time in any constituent or in formula I, its definition on each occurrence is independent of its definition at every other occurrence. Also, combinations of substituents and/or variables are permissible only if such combinations result in stable compounds.
As used herein except where noted, xe2x80x9calkylxe2x80x9d is intended to include both branched- and straight-chain saturated aliphatic hydrocarbon groups having the specified number of carbon atoms (Me is methyl, Et is ethyl, Pr is propyl, Bu is butyl); xe2x80x9calkoxyxe2x80x9d represents a linear or branched alkyl group of indicated number of carbon atoms attached through an oxygen bridge; xe2x80x9cHaloxe2x80x9d, as used herein, means fluoro, chloro, bromo and iodo; and xe2x80x9ccounterionxe2x80x9d is used to represent a small, single negatively-charged species, such as chloride, bromide, hydroxide, acetate, trifluoroacetate, perchlorate, nitrate, benzoate, maleate, sulfate, tartrate, hemitartrate, benzene sulfonate, and the like.
The term xe2x80x9cC3-7cycloalkylxe2x80x9d is intended to include cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl and cycloheptyl, and the like.
The term xe2x80x9cC7-12 bicyclic alkylxe2x80x9d is intended to include bicyclo[2.2.1]heptyl (norbornyl), bicyclo[2.2.2]octyl, 1,1,3-trimethyl-bicyclo[2.2.1]heptyl (bornyl), and the like.
The term xe2x80x9carylxe2x80x9d as used herein except where noted, represents a stable 6- to 10-membered mono- or bicyclic ring system. The aryl ring can be unsubstituted or substituted with one or more of C1-4 lower alkyl; hydroxy; alkoxy; halogen; amino. Examples of xe2x80x9carylxe2x80x9d groups include phenyl and naphthyl.
The term xe2x80x9cheterocyclexe2x80x9d or xe2x80x9cheterocyclic ringxe2x80x9d, as used herein except where noted, represents a stable 5- to 7-membered mono- or bicyclic or stable 9- to 10-membered bicyclic heterocyclic ring system any ring of which may be saturated or unsaturated, and which consists of carbon atoms and from one to four heteroatoms selected from the group consisting of N, O and S, and wherein the nitrogen and sulfur heteroatoms may optionally be oxidized, and the nitrogen heteroatom may optionally be quaternized, and including any bicyclic group in which any of the above-defined heterocyclic rings is fused to a benzene ring. Bicyclic unsaturated ring systems include bicyclic ring systems which may be partially unsaturated or fully unsaturated. Partially unsaturated bicyclic ring systems include, for example, cyclopentenopyridinyl, benzodioxan, methylenedioxyphenyl groups. Especially useful are rings containing one oxygen or sulfur, one to four nitrogen atoms, or one oxygen or sulfur combined with one or two nitrogen atoms. The heterocyclic ring may be attached at any heteroatom or carbon atom which results in the creation of a stable structure. Examples of such heterocyclic groups include piperidinyl, piperazinyl, 2-oxopiperazinyl, 2-oxopiperidinyl, 2-oxopyrrolodinyl, 2-oxoazepinyl, azepinyl, pyrrolyl, 4-piperidonyl, pyrrolidinyl, pyrazolyl, pyrazolidinyl, imidazolyl, imidazolinyl, imidazolidinyl, pyridyl; pyrazinyl, pyrimidinyl, pyridazinyl, oxazolyl, oxazolidinyl, isoxazolyl, isoxazolidinyl, morpholinyl, thiazolyl, thiophenyl, oxazolyl, thiazolidinyl, isothiazolyl, quinuclidinyl, isothiazolidinyl, indolyl, quinolinyl, isoquinolinyl, benzimidazolyl, thiadiazoyl, benzopyranyl, benzothiazolyl, benzoxazolyl, furyl, tetrahydrofuryl, tetrahydropyranyl, tetrazole, thienyl, benzothienyl, thiamorpholinyl, thiamorpholinyl sulfoxide, thiamorpholinyl sulfone, and oxadiazolyl. Morpholino is the same as morpholinyl. Unsaturated heterocyclic nrngs may also be referred to hereinafter as xe2x80x9cheteroarylxe2x80x9d rings.
The pharmaceutically-acceptable salts of the compounds of Formula I (in the form of water- or oil-soluble or dispersible products) include the conventional non-toxic salts such as those derived from inorganic acids, e.g. hydrochloric, hydrobromoic, sulfuric, sulfamic, phosphoric, nitric and the like, or the quaternary ammonium salts which are formed, e.g., from inorganic or organic acids or bases. Examples of acid addition salts include acetate, adipate, alginate, aspartate, benzoate, benzenesulfonate, bisulfate, butyrate, citrate, camphorate, camphorsulfonate, cyclopentanepropionate, digluconate, dodecylsulfate, ethanesulfonate, fumarate, glucoheptanoate, glycerophosphate, hemisulfate, heptanoate, hexanoate, hydrochloride, hydrobromide, hydroiodide, 2-hydroxyethanesulfonate, lactate, maleate, methanesulfonate, 2-naphthalenesulfonate, nicotinate, nitrate, oxalate, pamoate, pectinate, persulfate, 3-phenylpropionate, picrate, pivalate, propionate, succinate, sulfate, tartrate, thiocyanate, tosylate, and undecanoate. Base salts include ammonium salts, alkali metal salts such as sodium and potassium salts, alkaline earth metal salts such as calcium and magnesium salts, salts with organic bases such as dicyclohexylamine salts, N-methyl-D-glucamine, and salts with amino acids such as arginine, lysine, and so forth. Also, the basic nitrogen-containing groups may be quatemized with such agents as lower alkyl halides, such as methyl, ethyl, propyl, and butyl chloride, bromides and iodides; dialkyl sulfates like dimethyl, diethyl, dibutyl; and diamyl sulfates, long chain halides such as decyl, lauryl, myristyl and stearyl chlorides, bromides and iodides, aralkyl halides like benzyl and phenethyl bromides and others.
Some abbreviations that may appear in this application are as follows.
In vitro Assay for Determining Proteinase Inhibition
Assays of human xcex1-thrombin and human trypsin were performed by the methods substantially as described in Thrombosis Research, Issue No. 70, page 173 (1993) by S. D. Lewis et al.
The assays were carried out at 25xc2x0 C. in 0.05 M TRIS buffer pH 7.4, 0.15 M NaCl, 0.1% PEG. Trypsin assays also contained 1 mM CaCl2. In assays wherein rates of hydrolysis of a p-nitroanilide (pna) substrate were determined, a Thermomax 96-well plate reader was used was used to measure (at 405 nm) the time dependent appearance of p-nitroaniline. sar-PR-pna was used to assay human xcex1-thrombin (Km=125 xcexcM) and bovine trypsin (Km=125 xcexcM). p-Nitroanilide substrate concentration was determined from measurements of absorbance at 342 nm using an extinction coefficient of 8270 cmxe2x88x921Mxe2x88x921.
In certain studies with potent inhibitors (Ki less than 10 nM) where the degree of inhibition of thrombin was high, a more sensitive activity assay was employed. In this assay the rate of thrombin catalyzed hydrolysis of the fluorogenic substrate Z-GPR-afc (Km=27 xcexcM) was determined from the increase in fluorescence at 500 nm (excitation at 400 nm) associated with production of 7-amino-4-trifluoromethyl coumarin. Concentrations of stock solutions of Z-GPR-afc were determined from measurements of absorbance at 380 nm of the 7-amino-4-trifluoromethyl coumarin produced upon complete hydrolysis of an aliquot of the stock solution by thrombin.
Activity assays were performed by diluting a stock solution of substrate at least tenfold to a final concentration=0.1 Km into a solution containing enzyme or enzyme equilibrated with inhibitor. Times required to achieve equilibration between enzyme and inhibitor were determined in control experiments. Initial velocities of product formation in the absence (Vo) or presence of inhibitor (Vi) were measured. Assuming competitive inhibition, and that unity is negligible compared Km/[S], [I]/e, and [I]/e (where [S], [I], and e respectively represent the total concentrations, of substrate, inhibitor and enzyme), the equilibrium constant (Ki) for dissociation of the inhibitor from the enzyme can be obtained from the dependence of Vo, Vi on [I] shown in equation 1:
Vo, Vi=1+[I]/Kixe2x80x83xe2x80x83(1).
The activities shown by this assay indicate that the compounds of the invention are therapeutically useful for treating various conditions in patients suffering from unstable angina, refractory angina, myocardial infarction, transient ischemic attacks, atrial fibrillation, thrombotic stroke, embolic stroke, deep vein thrombosis, disseminated intravascular coagulation, and reocclusion or restenosis of recanalized vessels. The compounds of the invention are selective compounds, as evidenced by their inhibitory activity against human trypsin (represented by Ki).
Thrombin Inhibitorsxe2x80x94Therapeutic Usesxe2x80x94Method of Using
Anticoagulant therapy is indicated for the treatment and prevention of a variety of thrombotic conditions, particularly coronary artery and cerebrovascular disease. Those experienced in this field are readily aware of the circumstances requiring anticoagulant therapy. The term xe2x80x9cpatientxe2x80x9d used herein is taken to mean mammals such as primates, including humans, sheep, horses, cattle, pigs, dogs, cats, rats, and mice.
Thrombin inhibition is useful not only in the anticoagulant therapy of individuals having thrombotic conditions, but is useful whenever inhibition of blood coagulation is required such as to prevent coagulation of stored whole blood and to prevent coagulation in other biological samples for testing or storage. Thus, the thrombin inhibitors can be added to or contacted with any medium containing or suspected of containing thrombin and in which it is desired that blood coagulation be inhibited, e.g., when contacting the mammals blood with material selected from the group consisting of vascular grafts, stents, orthopedic prosthesis, cardiac prosthesis, and extracorporeal circulation systems.
Compounds of the invention are useful for treating or preventing venous thromboembolism (e.g. obstruction or occlusion of a vein by a detached thrombus; obstruction or occlusion of a lung artery by a detached thrombus), cardiogenic thromboembolism (e.g. obstruction or occlusion of the heart by a detached thrombus), arterial thrombosis (e.g. formation of a thrombus within an artery that may cause infarction of tissue supplied by the artery), atherosclerosis (e.g. arteriosclerosis characterized by irregularly distributed lipid deposits) in mammals, and for lowering the propensity of devices that come into contact with blood to clot blood.
Examples of venous thromboembolism which may be treated or prevented with compounds of the invention include obstruction of a vein, obstruction of a lung artery (pulmonary embolism), deep vein thrombosis, thrombosis associated with cancer and cancer chemotherapy, thrombosis inherited with thrombophilic diseases such as Protein C deficiency, Protein S deficiency, antithrombin III deficiency, and Factor V Leiden, and thrombosis resulting from acquired thrombophilic disorders such as systemic lupus erythematosus (inflammatory connective tissue disease). Also with regard to venous thromboembolism, compounds of the invention are useful for maintaining patency of indwelling catheters.
Examples of cardiogenic thromboembolism which may be treated or prevented with compounds of the invention include thromboembolic stroke (detached thrombus causing neurological affliction related to impaired cerebral blood supply), cardiogenic thromboembolism associated with atrial fibrillation (rapid, irregular twitching of upper heart chamber muscular fibrils), cardiogenic thromboembolism associated with prosthetic heart valves such as mechanical heart valves, and cardiogenic thromboembolism associated with heart disease.
Examples of arterial thrombosis include unstable angina (severe constrictive pain in chest of coronary origin), myocardial infarction (heart muscle cell death resulting from insufficient blood supply), ischemic heart disease (local anemia due to obstruction (such as by arterial narrowing) of blood supply), reocclusion during or after percutaneous transluminal coronary angioplasty, restenosis after percutaneous transluminal coronary angioplasty, occlusion of coronary artery bypass grafts, and occlusive cerebrovascular disease. Also with regard to arterial thrombosis, compounds of the invention are useful for maintaining patency in arteriovenous cannulas.
Examples of atherosclerosis include arteriosclerosis.
Examples of devices that come into contact with blood include vascular grafts, stents, orthopedic prosthesis, cardiac prosthesis, and extracorporeal circulation systems.
The thrombin inhibitors of the invention can be administered in such oral forms as tablets, capsules (each of which includes sustained release or timed release formulations), pills, powders, granules, elixers, tinctures, suspensions, syrups, and emulsions. Likewise, they may be administered in intravenous (bolus or infusion), intraperitoneal, subcutaneous, or intramuscular form, all using forms well known to those of ordinary skill in the pharmaceutical arts. An effective but non-toxic amount of the compound desired can be employed as an anti-aggregation agent. For treating ocular build up of fibrin, the compounds may be administered intraocularly or topically as well as orally or parenterally.
The thrombin inhibitors can be administered in the form of a depot injection or implant preparation which may be formulated in such a manner as to permit a sustained release of the active ingredient. The active ingredient can be compressed into pellets or small cylinders and implanted subcutaneously or intra muscularly as depot injections or implants. Implants may employ inert materials such as biodegradable polymers or synthetic silicones, for example, Silastic, silicone rubber or other polymers manufactured by the Dow-Coming Corporation.
The thrombin inhibitors can also be administered in the form of liposome delivery systems, such as small unilamellar vesicles, large unilamellar vesicles and multilamellar vesicles. Liposomes can be formed from a variety of phospholipids, such as cholesterol, stearylamine or phosphatidylcholines.
The thrombin inhibitors may also be delivered by the use of monoclonal antibodies as individual carriers to which the compound molecules are coupled. The thrombin inhibitors may also be coupled with soluble polymers as targetable drug carriers. Such polymers can include polyvinlypyrrolidone, pyran copolymer, polyhydroxy-propyl-methacrylamide-phenol, polyhydroxyethyl-aspartamide-phenol, or polyethyleneoxide-polylysine substituted with palmitoyl residues. Furthermore, the thrombin inhibitors may be coupled to a class of biodegradable polymers useful in achieving controlled release of a drug, for example, polylactic acid, polyglycolic acid, copolymers of polylactic and polyglycolic acid, polyepsilon caprolactone, polyhydroxy butyric acid, polyorthoesters, polyacetals, polydihydropyrans, polycyanoacrylates and cross linked or amphipathic block copolymers of hydrogels.
The dosage regimen utilizing the thrombin inhibitors is selected in accordance with a variety of factors including type, species, age, weight, sex and medical condition of the patient; the severity of the condition to be treated; the route of administration; the renal and hepatic function of the patient; and the particular compound or salt thereof employed. An.ordinarily skilled physician or veterinarian can readily determine and prescribe the effective amount of the drug required to prevent, counter, or arrest the progress of the condition.
Oral dosages of the thrombin inhibitors, when used for the indicated effects, will range between about 0.01 mg per kg of body weight per day (mg/kg/day) to about 30 mg/kg/day, preferably 0.025-7.5 mg/kg/day, more preferably 0.1-2.5 mg/kg/day, and most preferably 0.1-0.5 mg/kg/day (unless specificed otherwise, amounts of active ingredients are on free base basis). For example, an 80 kg patient. would receive between about 0.8 mg/day and 2.4 g/day, preferably 2-600 mg/day, more preferably 8-200 mg/day, and most preferably 8-40 mg/kg/day. A suitably prepared medicament for once a day administration would thus contain between 0.8, mg and 2.4 g, preferably between 2 mg and 600 mg, more preferably between 8 mg and 200 mg, and most preferably 8 mg and 40 mg, e.g., 8 mg, 10 mg, 20 mg and 40 mg. Advantageously, the thrombin inhibitors may be administered in divided doses of two, three, or four times daily. For administration twice a day, a suitably prepared medicament would contain between 0.4 mg and 4 g, preferably between 1 mg and 300 mg, more preferably between 4 mg and 100 mg, and most preferably 4 mg and 20 mg, e.g., 4 mg, 5 mg, 10 mg and 20 mg.
Intravenously, the patient would receive the active ingredient in quantities sufficient to deliver between 0.025-7.5 mg/kg/day, preferably 0.1-2.5 mg/kg/day, and more preferably 0.1-0.5 mg/kg/day. Such quantities may be administered in a number of suitable ways, e.g. large volumes of low concentrations of active ingredient during one extended period of time or several times a day, low volumes of high concentrations of active ingredient during a short period of time, e.g. once a day. Typically, a conventional intravenous formulation may be prepared which contains a concentration of active ingredient of between about 0.01-1.0 mg/ml, e.g. 0.1 mg/ml, 0.3 mg/ml, and 0.6 mg/ml, and administered in amounts per day of between 0.01 ml/kg patient weight and 10.0 ml/kg patient weight, e.g. 0.1 ml/kg, 0.2 ml/kg, 0.5 ml/kg. In one example, an 80 kg patient, receiving 8 ml twice a day of an intravenous formulation having a concentration of active ingredient of 0.5 mg/ml, receives 8 mg of active ingredient per day. Glucuronic acid, L-lactic acid, acetic acid, citric acid or any pharmaceutically acceptable acid/conjugate base with reasonable buffering capacity in the pH range acceptable for intravenous administration may be used as buffers. Consideration should be given to the solubility of the drug in choosing an The choice of appropriate buffer and pH of a formulation, depending on solubility of the drug to be administered, is readily made by a person having ordinary skill in the art.
The compounds can also be administered in intranasal form via topical use of suitable intranasal vehicles, or via transdermal routes, using those forms of transdermal skin patches well known to those of ordinary skill in that art. To be administered in the form of a transdermal delivery system, the dosage administration will, or course, be continuous rather than intermittent throughout the dosage regime.
The thrombin inhibitors are typically administered as active ingredients in admixture with suitable pharmaceutical diluents, excipients or carriers (collectively referred to herein as xe2x80x9ccarrierxe2x80x9d materials) suitably selected with respect to the intended form of administration, that is, oral tablets, capsules, elixers, syrups and the like, and consistent with convention pharmaceutical practices.
For instance, for oral administration in the form of a tablet or capsule, the active drug component can be combined with an oral, non-toxic, pharmaceutically acceptable, inert carrier such as lactose, starch, sucrose, glucose, methyl cellulose, magnesium stearate, dicalcium phosphate, calcium sulfate, mannitol, sorbitol and the like; for oral administration in liquid form, the oral drug components can be combined with any oral, non-toxic, pharmaceutically acceptable inert carrier such as ethanol, glycerol, water and the like. Moreover, when desired or necessary, suitable binders, lubricants, distintegrating agents and coloring agents can also be incorporated into the mixture. Suitable binders include starch, gelatin, natural sugars such as glucose or beta-lactose, corn-sweeteners, natural and synthetic gums such as acacia, tragacanth or sodium alginate, carboxymethylcellulose, polyethylene glycol, waxes and the like. Lubricants used in these dosage forms include sodium oleate, sodium stearate, magnesium stearate, sodium benzoate, sodium acetate, sodium chloride and the like. Disintegrators include, without limitation, starch methyl cellulose, agar, bentonite, xanthan gum and the like.
Typical uncoated tablet cores suitable for administration of thrombin inhibitors are comprised of, but not limited to, the following amounts of standard ingredients:
Mannitol, microcrystalline cellulose and magnesium stearate may be substituted with alternative pharmaceutically acceptable excipients.
The thrombin inhibitors can also be co-administered with suitable anti-platelet agents, including, but not limited to, fibrinogen receptor antagonists (e.g. to treat or prevent unstable angina or to prevent reocclusion after angioplasty and restenosis), anticoagulants such as aspirin, thrombolytic agents such as plasminogen activators or streptokinase to achieve synergistic effects in the treatment of various vascular pathologies, or lipid lowering agents including antihypercholesterolemics (e.g. HMG CoA reductase inhibitors such as lovastatin, HMG CoA synthase inhibitors, etc.) to treat or prevent atherosclerosis. For example, patients suffering from coronary artery disease, and patients subjected to angioplasty procedures, would benefit from coadministration of fibrinogen receptor antagonists and thrombin inhibitors. Also, thrombin inhibitors enhance the efficiency of tissue plasminogen activator-mediated thrombolytic reperfusion. Thrombin inhibitors may be administered first following thrombus formation, and tissue plasminogen activator or other plasminogen activator is administered thereafter.
Typical doses of thrombin inhibitors of the invention in combination with other suitable anti-platelet agents, anticoagulation agents, or thrombolytic agents may be the same as those doses of thrombin inhibitors administered without coadministration of additional anti-platelet agents, anticoagulation agents, or thrombolytic agents, or may be substantially less that those doses of thrombin inhibitors administered without coadministration of additional anti-platelet agents, anticoagulation agents, or thrombolytic agents, depending on a patient""s therapeutic needs.
Compounds may be prepared, for example, by a common condensation reaction between a group having a carboxylic acid moiety and a group having an amino moiety, forming a peptide or amide bond. Compounds may be prepared by other means however, and suggested starting materials and procedures described below are exemplary only and should not be construed as limiting the scope of the invention.
In general, compounds having the general structure 
wherein the variables have the above-described meanings, can be prepared by reacting 
under conditions suitable for forming amide bond between the acid and the amine.
The 3-fluoroazaindoles are prepared by reaction of the azaindole with an electrophilic fluorinating agent such as 1-chloromethyl-4-fluoro-1,4-diazoniabicyclo[2.2.2]octane bis(tetrafluoroborate) in methanolic acetonitrile to give the 2-methoxy-3-fluoroazaindoline. Treatment with base gives the 3-fluoroazaindole. Obvious variations and modifications of the method to produce similar and obvious variants thereof, will be apparent to one skilled in the art.
The 6-halogenated pyrazinones are prepared from the unsubstituted pyrazinone by treatment with an electrophilic halogenating reagent such as NBS or NCS. Alternatively, the 6-chloropyrazinones are prepared from 2-chloro-3,5-dibromo-6-hydroxypyrazine by alkylation with an acetate equivalent such as ethylbromoacetate. Displacement with an amine then gives the ethyl 3-amino-5-bromo-1-carboxymethyl-6-chloropyrazinone. The bromine is reductively cleaved with tin hydride and a radical initiator. The 5,6-dichloropyrazinones are prepared from 2,3,5-trichloro-6-hydroxypyrazine using similar procedures. Obvious variations and modifications of the method to produce similar and obvious variants thereof, will be apparent to one skilled in the art.
Suitable carboxylic acid starting materials for 
may be prepared according to the following procedures.
Starting allylamine is condensed with acetaldehyde and cyanide in Step A to afford the aminonitrile. This is reacted in Step B with oxalyl chloride according to the method of Hoornaert [J. Heterocyclic Chem., 20, 919, (1983)] to give the pyrazinone. The olefin is oxidatively cleaved with ruthenium tetraoxide and the resulting aldehyde is converted to the acid by an oxidizing agent such as chromic acid in Step C. The 3-chloro group is then displaced by an ammonia equivalent, in this case p-methoxybenzylamine in Step D. The remaining chlorine is removed by reduction with Raney nickel in Step E and in Step F the p-methoxybenzyl group is removed by treatment with a strong acid such as TFA. 
Typically, solution phase amide couplings may be used to form the final product, but solid-phase synthesis by classical Merrifield techniques may be employed instead. The addition and removal of one or more protecting groups is also typical practice.
Modifications of the method will allow different W, R3, X and A groups contemplated by the scope of the broad claim below to be present by the use of an appropriate reagent or appropriately substituted starting material in the indicated synthetic step. For example the starting aldehyde in Step A can have as its side chain, ethyl, isopropyl, cyclopropyl, trifluoromethyl, and the like, to achieve the different operable values of R3. Likewise, different W groups can be present by the use of an appropriate amine in Step D. Different X groups can be present by the omission of step E, and by the use of a reagent such as oxalyl bromide in step B. Obvious variations and modifications of the method to produce similar and obvious variants thereof, will be apparent to one skilled in the art.
The acid from METHOD 1, Step C is coupled to the appropriate amine. The 3-chloro group is then displaced by the appropriate amine and a protecting group is then removed, if necessary, to give the final product.
Modifications of the method will allow different W, R3, and X groups contemplated by the scope of the broad claim below to be present by the use of an appropriate reagent or appropriately substituted starting material in the indicated synthetic step. Obvious variations and modifications of the method to produce similar and obvious variants thereof, will be apparent to one skilled in the art.
An ester of glycine, in this case the benzyl ester, is condensed with acetaldehyde and cyanide in Step A to afford the aminonitrile. This is reacted in Step B with oxalyl chloride to give the pyrazinone. The 3-chloro group is then displaced by the appropriate amine, in this case phenethylamine, in Step C. The ester is hydrolyzed in Step D and the remaining chlorine is then removed by hydrogenolysis in Step E. 
Starting allylamine is condensed with acetaldehyde and cyanide in Step A to afford the aminonitrile. This is reacted in Step B with oxalyl chloride according to the method of Hoornaert [J. Heterocyclic Chem., 20 919, (1983)] to give the pyrazinone. The olefin is oxidatively cleaved with ruthenium tetraoxide and the resulting aldehyde is converted to the acid by an oxidizing agent such as chromic acid in Step C. The 3-chloro group is then displaced by the appropriate amine, in this case phenethylamine, in Step D and the remaining chlorine is then removed by reduction with Raney nickel in Step E. 
Amide couplings to form the compounds of this invention can be performed by the carbodiimide method. Other methods of forming the amide or peptide bond include, but are not limited to the synthetic routes via an acid chloride, azide, mixed anhydride or activated ester. Typically, solution phase amide couplings are performed, but solid-phase synthesis by classical Merrifield techniques may be employed instead. The addition and removal of one or more protecting groups is also typical practice.
Modifications of the method will allow different W, R3,X and A groups contemplated by the scope of the broad claim below to be present by the use of an appropriate reagent or appropriately substituted starting material in the indicated synthetic step. For example the starting aldehyde in Step A can have as its side chain, ethyl, isopropyl, cyclopropyl, trifluoromethyl, and the like, to achieve the different operable values of R3. Likewise, different W groups can be present by the use of an appropriate amine in Step D. Different X groups can be present by the omission of step E, and by the use of a reagent such as oxalyl bromide in step B. Obvious variations and modifications of the method to produce similar and obvious variants thereof, will be apparent to one skilled in the art.
Formation of [RS]-3-benzyl-7-carboxymethyl-6-methyl-2-oxo-1,2,3,4-tetrahydro-1,7-naphthiridin-[7H]-8-one (5) is a useful intermediate for preparing compounds of the invention. 
It is prepared as follows:
Step A: Ethyl 6-Methyl-3-nitropyridone 4-Carboxylate 
To a slurry nitroacetamide ammonia salt (70.3 g, 581 mmol) in 400, mL of deionized water was added 100 g (633 mmol, 1.09 equiv.) of ethyl 2,4-dioxovalerate followed by a solution of piperdinium acetate (prepared by adding 36 mL of piperdine to 21 mL of acetic acid in 100 mL of water). The resulting solution was stirred at 40xc2x0 C. for 16 h then cooled in an ice bath. The precipitated product was filtered and washed with 50 mL of cold water to afford the above pyridone as a yellow solid.
1H NMR (CDCl3) d 6.43 (s, 1H), 4.35 (q, J=7 Hz, 2H), 2.40 (s, 3H), 1.35 (t, J=7 Hz, 3H).
Step B: Ethyl 2-Methoxy-6-methyl-3-nitropyridine 4-Carboxylate 
A solution of the pyridone from step A (6.2 g, 27.4 mmol) in 50 mL of DCM was treated with 4.47 g (30.2 mmol) of solid trimethyloxonium tetrafluoroborate and the mixture was stirred at 40xc2x0 C. until the reaction was judged to be complete by HPLC (typically 24-72 h). The reaction mixture was concentrated to one-third volume, loaded onto a silica gel column and eluted with 2:3 EtOAc/Hexane to afford the methoxy pyridine as a yellow liquid.
1H NMR (CDCl3) d 7.2 (s, 1H), 4.35 (q, J=7 Hz, 2H), 4.05 (s, 3H), 2.55 (s, 3H) 1.35 (t, J=7 Hz, 3H).
Step C: 4-Hydroxymethyl-2-methoxy-6-methyl-3-nitropyridine 
To a xe2x88x9270xc2x0 C. solution of ester from step B (5.4 g, 22.5 mmol) in 140 mL of DCM was added 56.2 mL (56.2 mmol) of DIBAL-H (1M in hexane) by dropping funnel. The resulting solution was stirred for 1 h then warrned to room temperature over an additional hour. The reaction mixture was quenched by the careful addition of saturated NaK tartrate. Stirring was continued for 30 min then the solid was filtered and washed with 100 mL of DCM. The filtrate was extracted with 2xc3x9750 mL of saturated NaK tartrate then brine (25 mL). The yellow solution was concentrated and chromatographed (2:3 EtOAc/Hexane) to afford the desired alcohol as a yellow solid.
1H NMR (CDC13) d 7.00 (s, 1H), 4.70 (s, 2H), 4.05 (s, 3H), 2.50 (s, 3H), 2.10 (bs, 1H).
Step D: 4-Formyl-2-methoxy-6-methyl-3-nitropyridine 
To a xe2x88x9270xc2x0 C. solution of oxalyl chloride (2.0 mL, 22 mmol) in 50 mL of DCM was added 3.4 mL (44 mmol) of DMSO in 10 mL of DCM by dropping funnel. After 2 min, the reaction mixture was treated with 3.99 g (20 mmol) of the alcohol from step C in 20 mL of DCM. The solution was stirred for an additional 15 min at xe2x88x9270xc2x0 C., treated with 14 mL (50 mmol) of Et3N and warmed to ambient temperature over 90 min. The reaction was quenched with 100 mL of water and the two phases were separated. The aqueous phase was extracted with 100 mL of DCM and the combined organic extracts were washed with 50 mL of brine and dried over MgSO4. The yellow solution was concentrated and chromatographed (2:3 EtOAc/Hexane) to afford the aldehyde as a yellow solid.
1H NMR (CDCl3) d 10.05 (s, 1H), 7.10 (s, 1H), 4.70 (s, 2H), 4.05 (s, 3H), 2.60 (s, 3H).
Step E: Methyl-2-benzyl-3-(4-[6-methyl-2-methoxy-3-nitropyridyl])-acrylate: 
To a 0xc2x0 C. solution of 2-benzyl-trimethylphosphonoacetate (1.36 g, 5.0 mmol) in 25 mL of THF was added 145 mg (4.75 mmol) of NaH. The mixture was stirred for 30 min before the dropwise addition of 930 mg (4.75 mmol) of 4-forrnyl-2-methoxy-3-nitropyridine in 15 mL of THF. The solution was then heated at 50xc2x0 C. for 3 h, cooled and evaporated. The residue was redissolved in 100 mL of EtOAc and quenched to pH=7 with saturated NH4Cl. The organic phase was washed with brine and dried over MgSO4. Column chromatography (2:3 EtOAc/Hexane) afforded the desired olefin as a mixture of E- and Z-isomers.
1H NMR (CDCl3) d 7.60 (s, 1H), 7.40-7.00 (m, 6H), 6.60 (2 singlets, 2H), 4.00 (2 singlets, 6H), 3.75 (2 singlets, 8H), 2.40 (2 singlets, 6H).
Step F: [RS]-3-Benzyl-6-methyl-8-methoxy-2-oxo-1,2,3,4-tetrahydro-1,7-naphthiridine: 
To a solution of nitro olefin from step E (1.6 g, 4.75 mmol) in 50 mL of EtOAc was added 400 mg of 10% Pd(C). Hydrogen gas was added and the solution was heated at 50xc2x0 C. for 16. The reaction mixture was filtered through Celite and the filtrate evaporated. Column chromatography (2:3 EtOAc/Hexane) afforded the bicyclic lactam as a white solid.
1H NMR (CDCl3) d 7.45 (bs, 1H), 7.40-7.20 (m, 5H), 6.45 (s, 1H), 3.95 (s, 3H), 3.35 (dd, 1H), 2.80 (m, 2H), 2.60 (m, 2H), 2.40 (s, 3H).
Step G: [RS]-3-Benzyl-6-methyl-2-oxo-1,2,3,4-tetrahydro-1,7-naphthiridin-[7H]-8-one: 
To a 23xc2x0 C. solution of methoxypyridine from step F (700 mg, 2.48 mmol) in 25 mL of dichloroethane was added 8.0 mL (8.0 mmol) of BBr3 (1M in DCM). An insoluble gum precipitates within 5 min and the reaction was allowed to stir an additional 90 min before quenching to pH=8 with saturated NaHCO3. The mixture was diluted with 100 mL of EtOAc and 10 mL THF. The aqueous phase was discarded and the organic solution was washed with 10 mL of water then 10 mL of brine. Evaporation of the solvent left a tan colored solid which was used without further purification.
1H NMR (CDCl3) d 8.20 (bs, 1H), 7.40-7.10 (m, 5H), 5.88 (s, 1H), 3.35 (dd, 1H), 2.80-2.50 (m, 4H), 2.25 (s, 3H).
Step H: [RS]-3-Benzyl-7-t-butoxycarbonylmethyl-6-methyl-2-oxo-1,2,3,4-tetrahydro-1,7-naphthiridin-[7H]-8-one: 
To a 23xc2x0 C. solution of pyridone from step G (630 mg, 2.5 mmol) in 20 mL of DMF was added 812 mg (2.5 mmol) of Cs2CO3 and 0.37 mL (2.5 mmol) of tert-butyl bromoacetate. The reaction mixture was allowed to stir for 16 h before removal of the solvent in vacuo. The mixture was diluted with 100 mL of EtOAc and 25 mL water. The aqueous phase was discarded and the organic solution was washed with 20 mL of brine. Evaporation of the solvent and chromatography (1:1 EtOAc/Hexane) of the resulting oil left the alkylated pyridone as a white solid.
1H NMR (CDCl3) d 7.84 (bs, 1H), 7.33-7.17 (m, 5H), 5.87 (s, 1H), 4.79 (q, J=17.2 Hz, 2H), 3.36 (dd, J=4.1,13.5 Hz, 1H), 2.79 (m, 1H), 2.65 (m, 2H), 2.48 (m, 1H), 2.23 (s, 3H), 1.48 (s, 9H).
Step I: [RS]-3-Benzyl-7-carboxymethyl-6-methyl-2-oxo-1,2,3,4-tetrahydro-1,7-naphthiridin-[7H]-8-one: 
To a 0xc2x0 C. solution of ester from step H (310 mg, 0.85 mmol) in 30 mL of DCM was added 8 mL of trifluoroacetic acid. The reaction mixture was allowed to stir to ambient temperature over 5 h before removal of the solvent in vacuo. The resulting solid was azeotroped with benzene, EtOAc then ether. This process yielded the desired carboxylic acid as a white solid.
1H NMR (DMSO-d6) d 8.92 (bs, 1H), 7.35-7.10 (m, 5H), 6.04 (s, 1H), 4.75 (q, J=17.2 Hz, 2H), 3.16 (dd, J=4.2,13.7 Hz, 1H), 2.79 (m, 1H), 2.65-2.40 (m, 3H), 2.1 (s, 3H).
Additional exemplary compounds of the invention, shown in Tables 2 and 3, can be prepared according to the general schemes which follow the table and which are subsequently exemplified.

R is in dependently hydrogen, C1-5 alkyl, or the two R groups may be joined together to formn a 5-, 6-, or 7-membered ring unsubstituted, mono-substituted, independently di-substituted, or independently tri-substituted with C1-5 alkyl groups. 
R is independently hydrogen, C1-5 alkyl, or the two R groups may be joined together to form a 5-, 6-, or 7-membered ring unsubstituted, mono-substituted, independently di-substituted, or independently tri-substituted with C1-5 alkyl groups.
R1 is hydrogen or C1-5 alkyl unsubstituted or substituted with cyclopropane. 
In the following Examples HPLC Method A and HPLC Method B refer to the following methods:
HPLC Method A:
Vydac C18 reverse phase column
95:5:0.1 to 0:100:0.1 H2O:CH3CN:TFA gradient over 15 minutes
flow rate 2 mL/min
HPLC Method B:
Vydac C18 reverse phase column
95:5:0.1 to 5:95:0.1 H2O:CH3CN:TFA gradient over 45 minutes flow rate 1.5 mL/min